Book reviews : Chronic Illness: Impact and Interventions. 2d ed. by Ilene Morof Lubkin. 1990. Jones and Bartlett Publishers. 20 Park Plaza, Bos ton, MA 02116. 457 pages. $32.00

Everyone associated with the field of home health care is aware of the impact of chronic illness on health care resources as well as on the economic structure of this country. Although we are aware of the influence of chronic illness, the definition of chronic illness is varied. Chronic illness is not simply the reverse or extension of acute illness but rather a unique state that impacts on the social, psychological, ethical, and financial aspects of the individual, their family and the community. Lubkin equates chronic illness to a &dquo;guest&dquo; who comes to

r!pHIS work owes its origin to the views which broke upon the mind -Bof the author, after he had, in the year 1S00, been engaged in translating into French Dr. IIendy's " Observations on the Glandular yiseases of Barbadoes." He was astonished, he says, when he saw, 111 the description of the English author, the history of a disease whose scat was evidently in the absorbents, whilst its symptoms and progress ^erc analogous with those of several affections which had been attributed to various organs and another order of vessels. At first, his n?tions of this disease were only those at that time generally prevalent; one of which was, that the peculiarities iu its phenomena were the proper effects of the particular climate and soil of the island in ^hich it was cndemical; but, on regarding it more attentively, he inferred that an affection which prevailed especially in seasons productive of inflammatory diseases,?which gradually became endemic as that atmospheric constitution bccame established,?and which alternated sometimes with fevers, and at others with inflammation of the v>scera,?required for its production only a concourse of circumstances M hich every climate might present. This notion led to a series of researches, the results of which were published, in 1806', in a work of Ayhich the title was " A History of a Disease peculiar to the Lymphatic System," but which was afterwards changed to that of "A History ?* the Elephantiasis of the Arabs;" and at the same time that the author's inquirios enabled him to recognize the existence of the same nialady in Asia, Africa, America, and even in Europe, he was again struck by the great number of relations and points of analogy which presented with several other affcctions; and these relations and analogies induced him to consider the absorbent system as u structure 3 g 2 412 Foreign Medical Science and Literature. having an importance in the animal economy very different from that which had hitherto been imagined. From this time the horizon of his views extended before his eyes, and he soon perceived that no precise knowledge of the extent of the disorders dependant on this system was yet possessed ; and that he was in the way for attaining some discoveries that would reflect a new light on the proximate causes of diseases in general. Since that time, he has done what his clinical experience, literary researches, and powers of reflection, would enable him to effect towards the attainment of the object here alluded to; and the work we are about to take into consideration presents the general results of his labours.
The author, in his Prefacc, endeavours to obviate some prejudices which he supposes to exist against such a work, and to conciliate the minds of his readers to its principal object. " A book of theory,' he says, " a book on the proximate causes of diseases, is brought forth very incongruously in an age when the disposition given to the minds of medical students leads them only to empiricism. I venture to believe, however, that a little reflection will lead to notions more conformable with the true interests of science. The illustrious Professor of the School of Paris who, one of the first, turned the minds of his contemporaries from theoretical speculations, reprobated only vain and futile theories, composed, almost solely, of vague and insignificant terms which passed current in the ancient schools. It appears to me that he has been but ill understood, when it has been supposed that he intended that we should constantly observe diseases without ever occupying ourselves with considerations respecting their origin." It is, he adds, " undoubtedly necessary to observe, and to observe well* facts; but these facts would remain barren, if we did not trace their relations, and thcnce form some general inferences respecting them, without which there can be no science." Much of the declamation against theory with which they are pestered in France, as well as we arc in England, has, it appears, then, arisen from a vague employment of terms: some men of good judgment have used the word theory when reprobating, not a general expression of inferences immediately drawn from frets, but conclusions founded, more or less extensively, on inferences raised on supposititious bases ;* and then certain persons who are very apt at echoing, ??and who arc qualified to do nothing else than echo,?the expressions of men of place or merit, apply it to all sorts of reasoning ; whilst their own conduct, to complete the absurdity of the matter, is such as is described so exactly and laconically in the cited passage introduced at the commencement of the review of the work of Mr. Begin.
The work of Dr. Alard is constituted of two distinct parts: the one treating of the distribution of the absorbents, and the part those vessels perform in the vital functions in the state of health; the other, of their action in the phenomena of diseases. The anatomical and physiological disquisition occupies the whole of the first of the two volumes * The word hypo-ihesis expresses very well (in conformity with a general admission in modern languages,) this sort of reasoning; ami it is a pity that a'" writers will not employ it where it is necessary. display the bases of his inferences, and discuss the obvious objections to his conclusions, in such a manner as to relieve any of his readers from the necessity of seeking elsewhere for the most important of the facts which appear to support, or to oppose, the system of pathology Which he has here developed. In the analysis we are about to give of this work, we shall suppose the reader to be informed of many things of which the author has considered it proper to produce detailed observations, but which are familiar to all physiologists; as well as of several inductions from facts, equally well understood, that he has not advanced without a narration of the evidence on which they are established.
Dr. Alard commences his work with the following proposition:? " J hat which constitutes the basis of the body of man and of the most part of animals, is a tissue of vessels of diverse nature. 1 he hardest parts themselves are but a vascular assemblage: their hardness depends ?nly on the matter contained in the vessels, as the fleshy appearance has no other cause than the presence of blood, or of a sanguineous fluid, in the interior of those canals." In support of this proposition, the author first notices the observations of Haller, King, Ruyscii, and several other and later anatomists, which tend to show that the smallest perceptible portion ot the structures of the animal body, even though, using the expression of Waller, it be no bigger than a grain of sand, is found, on examination by the microscope, to present a multitude of small vessels, different orders ?f which are tilled with their proper fluids. The failure of injections to demonstrate this mode of structure in the bones, the brain, and some other parts, in first trials, was considered to present an objection to the generality of the inference above stated: but, as early as 1/39, a French academician, on examining, with the aid of a good microscope, hones tinged with madder, found them to present, first a tissue of white fibres, then one of a reddish colour, under this a third, and then a fourth, of deeper-coloured fibres; so that the bone was, throughout the coloured part, wholly penetrated as it were by a natural injection.
Some preparations of the bones, made by Scarpa, and preserved in fie museum at the University of Pavia, seem also to show that the basis of the osseous structure is nothing but an aggregate of vessels. 1'he brain was found by Leuwenhoek to be constituted, as far as the powers of the microscope could inform his sense of vision, wholly of a congeries of vessels filled with various fluids. These observations of Leuwenhoek were soon afterwards supported by others of a simi-,ar kind, made by Vjeussens. We noticed the principal arguments f?r the application of (he same general inference to the structure of the eye and several other organs, as well as the membranes formed in inflammations, when we gave an account of the Dissertation of Dr. *ELJCI on this subject, in a late Number of this Journal. The author's researches on this point have been very extensive : he has, indeed, made himself acquainted with every thing of importance that has been advanced in support of the proposition with which the 5 4l 4r Foreign Medical Science and Literature. chapter commences. It docs not, however, come within our views to noticc the observations in detail; as they are amongst those which may be supposed to be generally understood. Some facts may, however, be adduced respecting the tubular structure of the muscular fibres, ?which was first asserted by King, (in a paper published in the Philosophical Transactions,)?that will, perhaps, be novel to some of our readers.
After Blancaudi had, as he asserted, injected the muscular fibres by means of the arteries distributed to them, Muys, on throwing warm water into the crural artery of a lamb, perceived the muscular fibres lose their colour and become entirely white: on passing, then, a coloured fluid into the artery, he found the muscles assume the colour of the liquid, and, on examining them attentively with the microscope, he was satisfied that the smallest fibres of the muscles were filled with the liquid; whilst no vestige of it appeared in their interstices. This is conformable with what is stated by Haller, in his commentary on the Prelections of Boeuhaave; when he says, that " water injected into the coronary artery returned by the vein, at first coloured with blood ; but it was gradually seen to become paler and paler, until it was quite colourless. The heart, preserving its form, had become as w hite as the stomach or the bladder." We shall conclude our observations on this subject, with remarking that, notwithstanding the evidence presented by the facts above detailed or alluded to, many eminent anatomists of the present day believe in the existence of a simple laminated texture, forming the base of the cellular and other membranes; and that, whilst such a texture is intimately interwoven with vessels, which, especially when distended by injections, may appear to occupy it wholly, there yet remains a membranous expansion, not of u tubular nature. With respect to the tubular structure of the muscular fibres, we have, also, to remark, that Mr. Carlisle has stated (in his Croonian Lecture for 1805,) that he can distinctly sec an ultimate muscular fibre, which appears " as a solid cylinder, the covering of which is reticular membrane, and the contained part a pulpy substance irregularly granulated.
We know not, however, what to believe on this subject,?the statements of men of eminent talents arc so incongruous : for Leuwcnhock and Hook compare the ultimate muscular fibre to a string of pearls; Prochaska says it is as fine as a gossamer film, and extends throughout the whole length of a muscle; whilst Haller, admitting its filamentous character,. says it extends only to a short distance along a muscle; Muys asserts that it has a knotted appearance; Blancardi describes it as being contracted here and there; whilst Lecat says that it looks somewhat like a knotted reed: the greater number of anatomists, and amongst them Cuvier, agree, however, in stating, that the utmost powers of the microscope present it to us in the form of a solid cylinder, of a filamentous character, similar to the fibres which are cognizable by the unassisted visual powers.
With respect to the vascular nature of the ultimate muscular fibres, we may add the remark, that some physiologists have regarded the fact that the muscles, in cases of death from asphyxia, have been found Dr. Alard on the Scat and Nature of Diseases. 415 a brownish-red colour, whilst the blood in the arteries was of a deep.purple hue, as a proof of the combination of colouring matter *ith the muscular fibre itself; as, did the colour of the muscles depen-i otl blood circulating through them, they must assume the purple hue the blood. But this inference is not irrefragable, even were it not ?PP0sed by the fact that muscles may be washed white,* by injecting ^ater into their arteries. The ultimate fibres of a muscle may derive their colour from blood circulating through them, and yet preserve their ordinary hue when the larger vessels are filled with purple blood, 'n virtue of that law which causes certain vessels to admit only certain kinds of fluids to enter them under natural circumstances. This law ^as well appreciated by Bichat, in his reasonings on the functions of "is capillary system, when he endeavoured to explain why those vessels refused to admit the red blood unless their vitality had undergone some Modification ; and it is somewhat extraordinary that he did not apply >t to the condition of the muscular fibres in the case of asphyxia. ^ut, besides the vascular lymphatics capable of attaining a size vv,?ich renders them perceptible to our eyes and permits us to trace them with our instruments, there is another series of vessels, extremely Srnall in diameter, which anatomists have been accustomed to call by * Other physiologists than those above named have stated that tins may be cffecte(l; but Gorter seems to stand alone, when he asserts that a muscle thus Vva*hed white?pale as a membrane, he says,?will preserve the faculty ot con-, tracting ou being exeitcd.

41C)
Foreign Mcdical Science and Literature. different names, in conformity with their supposed uses; and wMcfi were regarded as artcrious by Iluysch, because he injected them by the arteries; as lymphatics, by Cruikshanks and Mascagni, because they injected them by the larger lymphatic vessels; and as venous by Dr. Ribes, because he has injected them by the veins. These circumstances, and the results of experiments on the absorption of fluids placed in contact with various surfaces, seem to warrant the inference that the sanguineous vessels are connected, by their parietes, with vessels which are distributed about the body in the utmost abundance, and developed on all the surfaces, exterior and interior; and which, though they generally carry only colourless fluids, transmit red blood under certain conditions. The influence of the vital powers in preserving the vessels last alluded to from the passage of red blood, is well shown by some experiments made by Professor Buniva.* He had obtained some curious results on injecting the arteries of dead animals with blood diluted with water; and, wishing to try the effect of a similar injection in a living animal, he tied the axillary artery of a calf, opened the vessel below the ligature, and urged the injection into it with considerable force. The liquid entered with difficulty, and presented no sign of its presence on the exterior of the limb. The spinal marrow was then divided near to the head: the heart and arteries almost instantly ceased to pulsate; the animal ceased to live; and, as suddenly, the diluted blood which remained in the syringe passed with rapidity into the limb, and showed itself on the surface, as it had done in his former experiments with injection of the same fluid. Some of the experiments here alluded to were made on the human body, where the injection, too, was thrown into the aorta; and, as these presented the greatest variety of interesting phenomena, we shall transcribe an account of their results on subjects of this kind.
The skin generally assumed a blood.red colour, whilst the palms of the hands had a fine rose tint; a blistered surface became tumid, reddened, and covered with drops of blood ; in certain parts,?the cheeks, for instance,?a bloody sweat broke out; the liver and the spleen swell-420 Foreign Medical Science and Literature. This last question is the subject of discussion in the fifth chapter of the work, before us, which commences with the proposition that " t'ie capillary system, such as it was conceived to be by Bichat, has no real existence." We shall pass over the evidence in the last chapter, tending to establish the inference of the existence of the pellucid vessels above alluded to: our limits will not permit us to give a comprehensive account of it; and it is, besides, detailed in works familiar to those versed in the study of anatomy. We could not do justice to the reasonings of the author on this evidence in an abstract, but we may remark that he has supported his inference in a very forcible manner. His arguments against the views of Bichat on the point just alluded to, serve to show that the functions attributed by this physiologist to his imaginary particular system of vessels, and the apparent laws by which those functions are regulated, are conformable with those of the absorbent system generally, and incongruous with those of the proper sanguiferous system. This discussion is continued through the subsequent chapter; in which he endeavours, more especially, to prove that " the exhalant and cellular systems are only dependences of the absorbent system." The subject is discussed, in a more general manner, in the seventh and eighth chapters; the objects of which are to show, that ''the active part of the parenchymatous substance of the organs is composed only of absorbent vessels and that " the absorbents are the sole agents of nutrition and growth, as well as of decrease and decripitude." We shall endeavour to give a view of the author's opinions on these subjects in a concise general abstract, without following him through his discussions; for, by proceeding, as he has done, from proposition to proposition, discussing each singly, he has been obliged to enter into many repetitions, which it is not requisite that we should detail.
One scries of repetitions in which he indulges, and which we may just notice here, is that in which he endeavours to show that the nerves, the muscles, the cellular texture, and, in a word, all the soft parts of the body, are constituted of a congeries of minute vessels^ variously arranged, containing fluids of diverse kinds, in virtue of the different vital properties, or modes of sensibility, which those vessels possess in the several organs or peculiar structures. These vessels, Dr. Alard believes, possess every where the power of contraction and dilatation, and receive diversities of fluids as they are differently excited by external agents; as we see, very well, in those of the conjunctiva of the eye, which, when stimulated, admit, or, using the author's expression, pump the red blood from the arteries with which they communicate. The only difference between the author's vie*? and that of Bichat on this point, seems to be that the former considers the functions of these vessels to be similar to those of the larger series which have ordinarily been termed absorbents,?a notion which has led him to regard the"w hole as one system, to be designated by one term; whilst Bichat considered them to be expressly analogous to the arteries, and indeed as the final expansions of these vessels. Bichatj however, it must be remarked, whilst he contemplated the abundant distribution of capillary vessels in every structure, did not suppose Dr. A lard on the Seat and Nature of Diseases,421 but that there existed also a sort of simple membranous expansion or laminated texture, which formed the bases of the parenchymatous structures in which those vessels are so copiously distributed, as well as of various other modes of simple fibrous arrangement.
The view of Dr. Alard,?that of minute pellucid vessels, spring. ,ng from the parietes of the small arteries; distributed in every point of the body; conveying different fluids and performing different organic functions, according as their vital properties are modified; having corresponding vessels, which may be said to spring from the jnost intimate texture of the organs, uniting into larger tubes, forming 'n some instances long continuous canals, (generally denominated absorbents,) in others running to be inserted in the parietes of veins, ~?-is one that is calculated to explain, more plausibly than any other, the mechanism of the distribution of the fluids for the purposes of the organic functions, and several of the most remarkable phenomena manifested in disordered states of those functions; whilst it does not want plausible arguments in its support, (as Dr. Alard has well proved,) and is, besides, calculated to obviate the difficulties which have been presented by the results of the experiments of Hunter, ?Magcndie, Brodie, and other eminent physiologists, on the mechanism of absorption. Still, it must be acknowledged, the author's inferences are founded, principally, on merely plausible suppositions ; but these Suppositions have lately received a very important degree of support in the discovery of Dr. Foiimann, of Heidelberg, of a communication of the lymphatics of the intestines with the mesenteric veins. It retires not a great stretch of analogy to infer?considering the evidence in favour of the existence of the pellucid vessels in question, presented by the observations and experiments of Ruysch, Cruick-?hanks, Ribes, (see page 415,) and several other anatomists,?that a communication which exists between a series of those vessels so large as to be palpable to the senses, exists also in such as are too minute to be thus recognized. 11 may be here asked : if the basis of all the organs is but a congeries of vessels, allied to absorbents by their nature, how is it that certain organs cxccute functions so different from those of other parts ; and, as an example, how is it that absorbents, arranged as a muscle, possess the power of contracting with such force as is witnessed in this species of organ ? To this the author would reply, that the same order of vessels possesses peculiar propertiessuperadded to the general characteristics of those vessels, in consequence of diversities in their alliances, arrangements, and the fluids they contain ; and, in respect to the contractility of the musclcs, he observes, that this faculty is the proper quality of absorbents ; so that, instead of saying that absorbents possess muscular properties, it would be better to say that muscles possess, in an eminent degree, the inherent property of those vessels,?that of contracting whenever they are submitted to exciting agents; and if, using his Own expressions, " muscles are provided with the contractile power in so high a degree, it is not to the peculiar nature of their fibres that they owe this prerogative, but to the manner in which those libres arc disposed in the intimate structure of those organs j to the union of 422 Foreign Medical Science and Literature. those innumerable bundles of parallel fibres, the contraction and agency of which all the surrounding parts concur in favouring." By admitting this hypothesis, we readily dispose of the difficulties which beset the questions of the structure of the urethra, uterus, iris, and choroid processes; and it is, in the structureof some polypi, &c. of course, applied to such a purpose by the author. The uterus, in his views, becomes muscular during pregnancy, because its vessels assume then that arrangement which constitutes a muscle; and it ceases to be muscular after parturition, because it then loses this particular arrangement. It is unfortunate, however, for this view of tho subject, that no such arrangement as that on which the author's inference is foundfcd is recognizable by our senses, in any stage of utcrogestatiotv. The absorbent vessel, then, is, according to Dr. Alard, the ?eat of irritability, whilst it is the most simple, and only essential, part of animal organization. The seat of irritability is a point that has so perplexed the most eminent physiologists, that one could almost wish that he could persuade himself,?as, in the want of sensitive evi-423 *n the means employed by nature. In inorganic bodies, attraction is sufficient in order that each portion of matter may find its proper place in the vast universe. In animals' bodies, sensibility produces the innumerable phenomena of vitality. The means on which absorption depends become, in muscles, in consequence of a particular disposition pf parts, the powerful motive agent by which an animal transports Jtself from one place to another. The same vessels which are every where else moveable, are in the bones gorged with calcareous phos.
phate, in virtue of the same principle, and thus become points of support and levers to the motive organs previously designated.
As the absorbent system is the part first formed in the fetus, so does predominate in the body during the earlier periods of life, or until the growth is completed: it then gradually loses its vitality; the fluids formerly absorbed by the exhalant order of vessels, are either retained *n the arteries, or they are returned into the torrent of the circulation by the veins ; the absorbents decay in their structure as well as In their functions; the glands cease to appear reddish and pulpy; the fluid, with which they had ordinarily been filled, disappears, and the organs themselves are often obliterated with age, and a plethora of the blood-vessels is the result. The bones also present signs of this species of change in the economy. The exhalant absorbents had carried to these structures the gelatinous and calcareous matter on which their cohesion and formation depended; the resorbing order of vessels gradually remove those vessels in old age; as this period of life exte*.ds, the bones become less hard and less weighty than in adult *ge; the compact substance of them diminishes in thickness; the cellules of the spongy tissue become more ample, the medullary cavity enlarges; the calibre of their blood-vessels increases; and, in a word, their calcareous matter returns into the torrent of the circulation, and ,s deposited in various parts; thus producing ossifications which often hasten the arrival of the final period of human existence. The successive changes in the human body above slightly alluded to* a?"e discussed in a very particular manner by Dr-AJard, who fiuds in them many phenomena, which he employs, with much force, in support of his views of the functions of the absorbent system in the animal economy. We can only recommend the more studious part d'f pur readers to peruse his work: our limits oblige us to pass over the important and often ingenious considerations it presents, in a very rapid manner, and in many instances wholly unnoticed. Dr. Alard'* general conclusions certainly amount to an hypothesis rather than to a theory; but it is an hypothesis that has much of plausibility, and the disquisitions adduced in its support are rendered extremely interesting by the multitude of curious facts,?many of which have been drawn from unmerited obscurity,?which the very extensive erudition of the author has enabled him to bring forward; as well as by the cool, candid, and intelligent manner in which they are conducted.
The proposition argued for in the ninth chapter, is that 11 the absorbent vessels of the nervous system draw from the blood the matter ?S the living solid.'' This chapter involves speculations which, to us, appear to have less of plausibility than any others in the work, and '5 424 Foreign Mcdical Science and Literature. such, indeed, as we do not think congruous with the author's general hypothesis. He thinks that the nerves are the organs first formed in the fetus, and that the nerves " form in their turn all the other organs, by means of the expansion of the numerous filaments which compose them, and which arc converted,?we might almost venture to say, which re-appear,?in cellular filaments, muscular fibres; in a word, in the nutritive parencyture of the organs." Why the author deprives the absorbents of powers, in the higher classes of animals, or those possessed of nerves, that he had conceded to them in a general manner, we cannot well discern.* The formation of nerves implies nutrition; which is a sufficient argument against these organs being the essential agents of this function. The priority in respect to the period of their formation to that of the other organs, admitting this antecedency to be proved, is but a feeble argument for the inference that these organs are produced by the nerves. This priority of formation is, however, denied by some emineht physiologists, amongst whom is Carus, who has shown so much accuracy of research in his work on the Nervous System. A pulsating vessel is said, by the physiologist just alluded to, to be the first distinct organ.
The arguments in favour of the proposition which is the subject of this chapter, only, as we think, tend to render it highly probable that the nerves have much influence in the functions of nutrition in the higher classes of animals: whilst it must, at the same time, be considered that nutrition is effected without nerves, not only at the first development of the human embryo, but in fully formed animals j unless we atjmit, with Oken, that a polypus is a mass in which the nervous matter exists in a state of fusion uniformly extended throughout the animal; but this proposition involves the existence of a faculty "without the presence of the organ of that faculty, or it implies the existence of properties in inorganic matter, that are afterwards said to be the peculiar attributes of a certain mode of organization. This sneaking, shuffling way of calling in the Epicurean philosophy to our aid, can never lead to any good: let us profess it openly and caudidly, if we do resort to it as the best means of escape from difficulties which perplex us. * " We have seen," says the author, in another place, " that, of the three orders of vessels which compose the bases of the solids of man, the only one to which we may give the denomination of the acting animal, according to the happy expression of Hunter, is that of the absorbents. We have seen that this order of vessels is solely charged with the labour of nutrition; that it presides over growth ill infancy, and is alone productive of decrease in old age; that, by means of a property quite exclusive, it draws from the air and from alimentary matters the principles capable of sustaining life; that it is the same vessels which combine them, assimilate them, and distribute them throughout the organs* and repel, by the emnnctories, the substances henceforth inappropriate for the exercise of the functions and the maintenance of existence." In another part of the work, the author speaks of the absorbent system as being " allied, confounded, and identified, with the nervous system." By this last statement, it is true, he may be considered to obviate the charge of incongruity, above advanced; but then it is by, as it appears to us, entering into extremely vague, or at best very hypothetical, and not very plausible, assumptions.

426
Foreign Medical Science and Literature. rious blood furnishes, also, an argument in favour of the samcr Inference. If, viewing this point in another direction, the veins below the subclavians received only the portion of arterious blood which has not been expended in nutrition, the secretions, and excretions, we should, it seems, find them contain a less volume of fluids than the arteries.
Purulent matter has been found in the abdominal veins, without any signs of inflammation of those vessels, when there has been collections of pus in the belly. This has been frequently observed by Professor Ciiaussier, especially after peritonitis; but this fact presents, it may be said by the partizans for venous absorption, equivocal indications. The anatomical facts in favour of the inference that pellucid vessels, having orifices opening on the surface of the peritoneum, and communicating with the adjacent veins, and those which seem to show that the venous ramifications are every.where continuous with the arteries, must turn the balance in favour of Dr. Alard's explanation.
Dr. Riees, who believed in venous absorption when he related* the fact we are about to notice, says that he had conjectured that the lymphatics in the medullary cavity of the bones, which absorb the marrow, terminated in veins ; and experience has partly verified his conjecture, by showing that, by injecting the hepatic veins, he could fill the superficial lymphatics of the liver. We have before noticed this point of anatomy; and shall therefore only add now, that this experiment, repeated several times with the same success, satisfied him that all the vessels of the order of lymphatics do not terminate in the thoracic duct. After the discovery of such a fact, it seems strange that the phenomena which at that time were considered to prove venous absorption, should any longer be thus interpreted.
Dr. Magendie thinks he has obviated these equivocal indications by some recent experiments, and proved that venous trunks absorb by their parietes. We shall elsewhere notice his memoir on this subject. The only circumstances that have been brought forward as proofs of the ramifications of veins presenting open mouths on the surfaces of the membranes and the cavities of the cellular tissue, are that fluids injected by the veins have been effused in those parts. But Dr. Itibes, ?who relates these facts, acknowledges that such results were to be obtained only when the experiment was made on a body in which putrefaction had commenced; and it seems, hence, so highly probable that rupture of the minute venous ramifications took place, so as to render this argument one of very little force in favour of venous absorption, or the communication of the cavities of those vessels with extraneous surfaces in the natural state of the parts.
The views of Dr. Alard seem to be alone qualified to explain the promptitude with which a considerable quantity of certain drinks sometimes passes from the intestinal canal to the urinary passages; how it happens that asparagus, prussiate of potash, and many other substances, when introduced into the stomach, soon manifest signs of their presence in the urine, whilst the venous blood, at least that * In the eighth volume of the Memoires de la Socidi Medicate d'Emulation. drawn from the arm, does not appear to contain them, or to have suffered any alteration ;?how a liquid charged with odorific principles, introduced into the abdominal cavity, immediately manifests itself in the veins; whilst an analogous liquid passed into the intestines, promptly appears in the lacteals, and remains a stranger to tho Veins;?how the milk possesses the odour and other predominant qualities of food and other substances received into the stomach, (by which a child is purged when its nurse has taken a cathartic;) whilst the blood and other secretions have no such odour or qualities;?and, lastly, how certain substances, as milk, water pure or mingled with turpentine, inserted in a wound of the integuments, penetrate the trunks of the valvular absorbents, and not into the veins; whilst certain other substances, as the upas tieute, for example, inserted in the same manner, pass rapidly into the veins, and do not appear in the valvular absorbents.
All these phenomena are readily explicable, if we admit the existence of absorbent lymphatics every where arising from the textures, a"d terminating in veins; so that little centres of absorption are formed, each of which, being modified according to the arrangement ?f the parts which give origin to it and the diversity of the exciting "gents affecting it, directs the absorbed matters to the veins, the lacteals, or certain excretory organs; whilst diversities in the sensibility, "t different times and in different parts, enables them to exert that specific action by which they select and transmit certain matters, and refuse to reccive others of a different kind.
Details on the rest of the points treated on in the divisions above enumerated, do not come within our intentions: we pass on, there-'?re, to the next chapter, in which the author treats of the structure and physiology of the mucous membranes, the cellular tissue, and the skin. The author's peculiar notions of the structure of these organs must be obvious, from what has been stated in former parts of this article. Excepting his assimilation of the functions of their capillary vessels to those of the absorbents, commonly so termed, his physiological considerations arc characterized by a judicious exposition of, What bad already been advanced, rather than by any remarkable novelty. He dwells much upon the similarity of the structure of the s^in and mucous membranes, and the analogy, in many respects, between their functions. We find some of the most remarkable proofs (,f the latter assertion in the lower classes of animals: the zoophyte which has the form of the finger of a glove, (the hydra jusca,) for example,?the interior of which is its digestive organ,?may be turned inside out, and yet the animal will live, having the functions of its two surfaces reversed. This, and the two ensuing chapters, in which the author treats of the development of animal heat,?-on the influence of the absorbent vessels on the establishment of the constitutions proper to each period of life,?and on the modification of temperaments in individuals,? seem to have been introduced in order that the account of the physiology of the absorbent system given in this work might be rendered complete, rather than with the intention of proposing any thing nove\ 3 i 2 428 Foreign Medical Science and Literature. of remarkable importance. His disquisition on the temperaments is, as he acknowledges, principally derived from the writings of Lorry, Cabanis, and Halle; with which we suppose our readers are well acquainted.
The subject just mentioned terminates the first volume of the work ; the second will become the subject of an article in the ensuing Number of this Journal.
Principes gencraux de Physiologie-Pathologiqac, coordonnes d'apres [In continuation from page 345.] The fifth chapter of the work of Mr. Begin treats of the local effects of irritation. On this subject Mr. Begin advances nothing of considerable importance that has not been stated in this Journal,